2615.Redeterminations

There are no mandatory reporting rules in the program for Extra Help with Medicare prescription drug costs. However, the law requires that SSA periodically redetermine a person's continuing eligibility for Extra Help with Medicare prescription drug costs and the amount of that help. We will schedule a redetermination of a person's eligibility for the Extra Help about a year after eligibility began. Each year, we will select cases for redetermination in the period August through December, rather than throughout the year. The redeterminations will generally be conducted by mail rather than face-to-face. Also, if you experience one of the events in §2615.1, you may want to request a redetermination if the event reduces your income and/or resources.

NOTE: Beginning January 1, 2011 a special rule applies to widows and widowers. When one member of a married couple dies, a redetermination can be delayed until one year after the report of death if the death could decrease or eliminate the amount of Extra Help.

2615.1What events can result in a redetermination of the amount of Extra Help you receive before the periodic redetermination?

  1. You get married;

  2. You and your spouse who lives with you divorce;

  3. Your spouse who lives with you dies;

  4. You and your spouse who lives with you separate;

  5. You and your spouse who lives with you have your marriage annulled; or

  6. You and your previously separated spouse begin living together again.

2615.2What happens to your Extra Help with Medicare prescription drug costs after you notify SSA of an event?

Certain changes in your situation (above) may affect the amount of Extra Help that you can receive to pay for your prescription drug costs. Based on the event and circumstances reported, SSA may adjust the amount of help you receive.

Last Revised: Nov. 30, 2010